Provider Demographics
NPI:1558378133
Name:POTTER, DELANA E (CRNA)
Entity Type:Individual
Prefix:
First Name:DELANA
Middle Name:E
Last Name:POTTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 CAPOOTH RD
Mailing Address - Street 2:
Mailing Address - City:RAMER
Mailing Address - State:TN
Mailing Address - Zip Code:38367-6163
Mailing Address - Country:US
Mailing Address - Phone:731-693-4858
Mailing Address - Fax:
Practice Address - Street 1:36 BRENTSHIRE SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2245
Practice Address - Country:US
Practice Address - Phone:731-664-1717
Practice Address - Fax:731-664-7114
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0000010789367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3634171Medicare ID - Type Unspecified